The Pursuit of Harpyness » Contraceptionhttp://www.harpyness.com
As narrated by the most charming and vicious women on the internetSat, 29 Sep 2012 11:37:30 +0000en-UShourly1http://wordpress.org/?v=3.8.5Birth Control Promoted in Afghanistanhttp://www.harpyness.com/2010/03/10/birth-control-promoted-in-afghanistan/
http://www.harpyness.com/2010/03/10/birth-control-promoted-in-afghanistan/#commentsWed, 10 Mar 2010 21:04:40 +0000http://www.harpyness.com/?p=14022In a country with the world’s second highest maternal mortality rate, health professionals are partnering with religious leaders to distribute condoms and promote spacing births. Afghanistan has one of the world’s highest fertility rates, averaging more than six babies per woman. The maternal death rate in Afghanistan is 1,800 per 100,000 live births; in the U.S. it’s 11 per 100,000 births.

The study–conducted by U.S.-based nonprofit Management Sciences for Health–involved 3,700 families in three rural areas with different ethnic groups. The Health Ministry collaborated with nonprofit organizations to educate people about birth control. Mullahs quoted from the Quran to promote breast-feeding for two years and explained the importance of spacing out births to give women and babies better health outcomes. The mullahs’ message–along with condoms–was often delivered during Friday prayers.

According to the report published Monday in the World Health Organization’s journal, Bulletin, use of the pill, condoms and injected forms of birth control rose to 27 percent over eight months once the benefits were explained one-on-one by health workers. “The fastest, cheapest, easiest way to reduce maternal deaths in Afghanistan is with contraception,” said the study’s lead author, Dr. Douglas Huber. I hope this approach catches on in other parts of Afghanistan (and around the world).

The Guttmacher Institute reports that as countries reduce restrictions in their abortion laws, the abortion rate has decreased. More good news: the drop in the unintended pregnancy rate and, in turn, the abortion rate can also be attributed to increased use of contraception.

Worldwide, the unintended pregnancy rate has declined and the proportion of married women and sexually active single women using contraception has increased. But contraceptive use varied greatly among regions. About one in four married African women have an unmet need for contraception, and 92 percent of African women live under highly restrictive abortion laws.

According to the report, abortion occurs at equal rates in regions with liberal abortion laws and regions with tight restrictions. But where abortion is illegal or highly restricted, unsafe abortion continues wreak havoc on women’s health and lives. Unsafe abortion causes approximately 70,000 deaths each year, most in the developing world. Millions more suffer serious complications.

The moral of the story is that contraception and safe, legal abortion saves women’s lives and decrease the number of abortions. Sharon Camp, president and CEO of the Guttmacher Institute, remarked that, “The evidence is strong and growing that empowering women with the means to decide for themselves when to become pregnant and how many children to have significantly lowers unintended pregnancy rates and thereby reduces the need for abortion.”

Today’s New York Times Health section ran a startling article about a new study that measured how effective the withdrawal method was at preventing pregnancy. It was sent to me by friend and frequent commenter Elibard, who knows entirely too much about my sex life, including that I am a strident enemy of withdrawal (as a method of contraception, that is. Otherwise, it can be fun). I simply know too many children conceived as a result of “Oh, I’ll pull out in time.” When asked, I will always loudly proclaim: USE CONDOMS. WITHDRAWAL DOES NOT WORK.

Turns out, I may be wrong. Well, sorta:

Reproductive experts were taken aback by a paper in the June issue of Contraception magazine. Based on an analysis of studies, the paper pronounced withdrawal “almost as effective as the male condom — at least when it comes to pregnancy prevention.”

“If the male partner withdraws before ejaculation every time a couple has vaginal intercourse, about 4 percent of couples will become pregnant over the course of a year,” the authors write.

For condoms, used optimally, the rate is about 2 percent. But more significant, the authors say, are the rates for “typical use,” because people can’t be expected to use any contraception method perfectly every time. Typical use of withdrawal leads to pregnancy 18 percent of the time, they write; for typical use of condoms 17 percent of the time.

Researchers on this study knew that health educators have always held the party line that withdrawal is the worst and most unreliable method of birth control. I know that every sex ed class I ever attended and every women’s health book that I ever read said as much. But they thought that withdrawal might be worth reconsidering:

“We had all noticed that social science researchers and health care providers just kind of dismiss withdrawal and don’t seem to realize that it can prevent pregnancy,” Ms. Jones said. “Most people seem to be under the impression that you might as well do nothing.”

But Ms. Jones said the intention was not to advocate withdrawal, but to advocate talking about it.

“Health care providers and health educators should discuss withdrawal as a legitimate, if slightly less effective, contraceptive method in the same way they do condoms and diaphragms,” the authors write. “Dismissing withdrawal as a legitimate contraceptive method is counterproductive for the prevention of pregnancy and also discourages academic inquiry into this frequently used and reasonably effective method.”

Ms. Jones and her co-authors said they were dismayed to see that withdrawal had not been exhaustively studied. (ed: heh heh)

There’s a big BUT here:

Some educators and physicians said they worried that putting out a message that withdrawal is effective would just give teenagers encouragement to have unprotected sex. And many underscored what the authors themselves point out: that unlike condoms, withdrawal does not protect against sexually transmitted diseases, a strong reason to encourage condoms.

Very true. There’s also the issue of whether consistent, responsible withdrawal is a practicable method for everyone:

“Those data don’t necessarily translate to youth today,” said Dr. Melissa Gilliam, chief of family planning and contraceptive research in the University of Chicago’s Department of Obstetrics and Gynecology, who is on the board of the Guttmacher Institute. “In terms of a reliable method used over and over again, the risk of failure is quite high.”

Martha Kempner, vice president for information and communications at the Sexuality Information and Education Council of the United States, said withdrawal, while less problematic for married or long-term monogamous couples, is not as acceptable in other circumstances because “well-intentioned young men can get it wrong, or somebody can just not do it after they said they would.”

Spirited comments on blogs largely agreed. “I wouldn’t want to trust a dude to get it right every time,” read one comment on the blog CollegeCandy.

It seems highly unlikely to me that men in their teens and 20s can control their ejaculation well enough to use the withdrawal method successfully. I’m not gratuitously slagging on young dudes, mind you. The simple truth is, learning how to delay ejaculation takes time and practice, and ladies, you don’t want to be the woman he’s learning on.

If you are in a monogamous relationship where there is absolute trust, and where you are very familiar with each other’s sexual responses, you might be able to get away with withdrawal as a method of contraception (at least, you could get away with it around 82% of the time, according to this study). Even with this study’s surprising results, I still wouldn’t chance it, but I’m so risk-averse I use condoms and the Pill. I’ve always been a total nervous Nelly about contraception (which has paid off; I’ve never gotten pregnant).

Elibard–who, like me, is in mid-thirties and, ahem, not a novice in the ways of love–said the same thing when we were e-mailing about this article:

No teenage boy (or early 20s) should even attempt this, in my opinion. Nor should any girl trust that he can do it. But I could see an older, more experienced man being able to swing it, so to speak. But it would also depend on personality. The more type-A, the better, I’d think.

Yes, all those focused, driven, goal-oriented men out there are strong candidates for withdrawal excellence! Sign them up! Get them practicing!

Despite my personal skepticism about the withdrawal method, I commend these researchers for this study. Investigating the success rates of any form of contraception is always a worthwhile pursuit. Women do not have enough reliable methods of contraception available to them, especially in the developing world. We can always use more active inquiry and unbiased studies in this field, even ones that seem counterintuitive and go against long-held judgements.